Healthcare Provider Details

I. General information

NPI: 1063980381
Provider Name (Legal Business Name): DENNIS GORDON GROVE LMHC CDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 36TH ST, STE 300
SEATTLE WA
98103
US

IV. Provider business mailing address

701 N 36TH ST, STE 300
SEATTLE WA
98103
US

V. Phone/Fax

Practice location:
  • Phone: 206-216-5000
  • Fax: 206-216-5002
Mailing address:
  • Phone: 206-216-5000
  • Fax: 206-216-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60984419
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60336500
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: